TY - JOUR
T1 - Impact of liver cirrhosis, severity of cirrhosis and portal hypertension on the difficulty of laparoscopic and robotic minor liver resections for primary liver malignancies in the anterolateral segments
AU - International Robotic and Laparoscopic Liver Resection Study Group Investigators
AU - Zheng, Junhao
AU - Liang, Xiao
AU - Wu, Andrew G. R.
AU - Kabir, Tousif
AU - Scatton, Olivier
AU - Lim, Chetana
AU - Hasegawa, Kiyoshi
AU - Sijberden, Jasper P.
AU - Aghayan, Davit L.
AU - Siow, Tiing Foong
AU - Dokmak, Safi
AU - Herman, Paulo
AU - Marino, Marco V.
AU - Mazzaferro, Vincenzo
AU - Chiow, Adrian K. H.
AU - Sucandy, Iswanto
AU - Ivanecz, Arpad
AU - Choi, Sung Hoon
AU - Lee, Jae Hoon
AU - Prieto, Mikel
AU - Vivarelli, Marco
AU - Giuliante, Felice
AU - Ruzzenente, Andrea
AU - Yong, Chee-Chien
AU - Yin, Mengqiu
AU - Chen, Zewei
AU - Fondevila, Constantino
AU - Efanov, Mikhail
AU - Morise, Zenichi
AU - di Benedetto, Fabrizio
AU - Brustia, Raffaele
AU - Dalla Valle, Raffaele
AU - Boggi, Ugo
AU - Geller, David
AU - Belli, Andrea
AU - Memeo, Riccardo
AU - Gruttadauria, Salvatore
AU - Mejia, Alejandro
AU - Park, James O.
AU - Rotellar, Fernando
AU - Choi, Gi-Hong
AU - Robles-Campos, Ricardo
AU - Wang, Xiaoying
AU - Sutcliffe, Robert P.
AU - Pratschke, Johann
AU - Lai, Eric C. H.
AU - Chong, Charing C. N.
AU - D'Hondt, Mathieu
AU - Monden, Kazuteru
AU - Lopez-Ben, Santiago
N1 - Funding Information: Dr B.K.P. Goh was partially funded by a grant from the Intuitive Foundation for this work. Any research findings, conclusions, or recommendations expressed in this work are those of the authors and not of the Intuitive Foundation. Funding Information: Dr M. Yin was partially funded by the Research Project of Zhejiang Provincial Public Welfare Fund project in the Field of Social development ( LGF20H160028 ). Funding Information: Dr T. P. Kingham was partially supported by the US National Cancer Institute MSKCC Core Grant number P30 CA008747 for this study. Publisher Copyright: © 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology
PY - 2024/1/1
Y1 - 2024/1/1
N2 - Introduction: We performed this study in order to investigate the impact of liver cirrhosis (LC) on the difficulty of minimally invasive liver resection (MILR), focusing on minor resections in anterolateral (AL) segments for primary liver malignancies. Methods: This was an international multicenter retrospective study of 3675 patients who underwent MILR across 60 centers from 2004 to 2021. Results: 1312 (35.7%) patients had no cirrhosis, 2118 (57.9%) had Child A cirrhosis and 245 (6.7%) had Child B cirrhosis. After propensity score matching (PSM), patients in Child A cirrhosis group had higher rates of open conversion (p = 0.024), blood loss >500 mls (p = 0.001), blood transfusion (p < 0.001), postoperative morbidity (p = 0.004), and in-hospital mortality (p = 0.041). After coarsened exact matching (CEM), Child A cirrhotic patients had higher open conversion rate (p = 0.05), greater median blood loss (p = 0.014) and increased postoperative morbidity (p = 0.001). Compared to Child A cirrhosis, Child B cirrhosis group had longer postoperative stay (p = 0.001) and greater major morbidity (p = 0.012) after PSM, and higher blood transfusion rates (p = 0.002), longer postoperative stay (p < 0.001), and greater major morbidity (p = 0.006) after CEM. After PSM, patients with portal hypertension experienced higher rates of blood loss >500 mls (p = 0.003) and intraoperative blood transfusion (p = 0.025). Conclusion: The presence and severity of LC affect and compound the difficulty of MILR for minor resections in the AL segments. These factors should be considered for inclusion into future difficulty scoring systems for MILR.
AB - Introduction: We performed this study in order to investigate the impact of liver cirrhosis (LC) on the difficulty of minimally invasive liver resection (MILR), focusing on minor resections in anterolateral (AL) segments for primary liver malignancies. Methods: This was an international multicenter retrospective study of 3675 patients who underwent MILR across 60 centers from 2004 to 2021. Results: 1312 (35.7%) patients had no cirrhosis, 2118 (57.9%) had Child A cirrhosis and 245 (6.7%) had Child B cirrhosis. After propensity score matching (PSM), patients in Child A cirrhosis group had higher rates of open conversion (p = 0.024), blood loss >500 mls (p = 0.001), blood transfusion (p < 0.001), postoperative morbidity (p = 0.004), and in-hospital mortality (p = 0.041). After coarsened exact matching (CEM), Child A cirrhotic patients had higher open conversion rate (p = 0.05), greater median blood loss (p = 0.014) and increased postoperative morbidity (p = 0.001). Compared to Child A cirrhosis, Child B cirrhosis group had longer postoperative stay (p = 0.001) and greater major morbidity (p = 0.012) after PSM, and higher blood transfusion rates (p = 0.002), longer postoperative stay (p < 0.001), and greater major morbidity (p = 0.006) after CEM. After PSM, patients with portal hypertension experienced higher rates of blood loss >500 mls (p = 0.003) and intraoperative blood transfusion (p = 0.025). Conclusion: The presence and severity of LC affect and compound the difficulty of MILR for minor resections in the AL segments. These factors should be considered for inclusion into future difficulty scoring systems for MILR.
KW - Cirrhosis
KW - Difficulty score
KW - Laparoscopic hepatectomy
KW - Laparoscopic liver
KW - Minimally-invasive hepatectomy
KW - Minimally-invasive liver
UR - http://www.scopus.com/inward/record.url?scp=85177036896&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ejso.2023.107252
DO - https://doi.org/10.1016/j.ejso.2023.107252
M3 - Article
C2 - 37984243
SN - 0748-7983
VL - 50
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 1
M1 - 107252
ER -